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CHAPTER 6 Oxygenation and ventilation
Vincent N. Mosesso, Jr and Angus M. Jameson
Introduction
Oxygenation and ventilation are critical life‐sustaining functions, and their evaluation and management are primary components of emergency medical services (EMS) care. While these two parameters are related, they are distinct physiological functions that require independent assessment. The focus of this chapter is on diagnostic aids and management, and EMS physicians and other clinicians must develop and maintain expert physical examination skills for the proper assessment of these important processes. The astute EMS clinician will observe demeanor, mentation, ability to speak, ease and volume of air exchange, work of breathing, upper or lower airway obstruction, pulmonary congestion, and central and peripheral cyanosis. These findings should be considered together with diagnostic test results to determine the status of oxygenation and ventilation in an individual patient, whether intervention is needed, and, if so, which treatment modalities are indicated.
Assessment of Oxygenation
Adequate oxygen delivery to body tissues is a necessity for life and is dependent on both the transfer of oxygen from the alveolar airspace to the blood and sufficient tissue perfusion with oxygenated blood. Oxygenation of the blood is dependent on a number of distinct factors, each of which can be impaired by various pathological processes (Table 6.1). Normal hemoglobin oxygen saturation in peripheral arterial blood is 96–99%. It is important to understand the relationship between oxygen saturation and the partial pressure of oxygen. This is depicted by the oxyhemoglobin dissociation curve (Figure 6.1). This curve demonstrates that above 90% the saturation percentage is very insensitive to changes in partial pressure of oxygen (PaO2) between 150 mmHg and 760 mmHg. This means that, especially in patients receiving supplemental oxygen, severe impairment of oxygen transfer into the blood can occur without major changes in the saturation level and